Written Verification

What is an attestation?

• An attestation is a legal and formal written statement.  If you sign an attestation related to an application, you are saying and confirming that what you are signing is true.

Caregiving Attestation

Who can provide the 1000 hour caregiving notarized attestation or verification for you? 

Only the following people may provide attestation or verification for you if they have observed you providing direct care:

• Supervisor;

• Employer;

• Co-worker;

• Client or resident if they are able to read, understand and sign the form in the presence of a notary, and be interviewed by telephone; or

• The resident’s spouse or family member.

Who cannot provide the 1000 hour caregiving attestation for you?

• Anyone related to you by blood or marriage; or

• A Home and Community Services case manager or a Division of Developmental Disabilities case manager.

What is included and verified as true in the notarized “attestation” of caregiving experience?

• The proposed licensee or resident manager has successfully provided 1000 hours of direct care and has caregiving experience.

• The dates of employment and any volunteer work experience as a long-term care worker that occurred after age 18 in a licensed or contracted setting.

• The individual verifies that work experience has occurred in the previous 60 months.

• The individual verifies that they were in a position to personally observe, over time, the applicant’s actual caregiving.

• The accurate address and telephone contact information for the individual completing the form so the attester can be interviewed by the department about the applicant’s caregiving experience.